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apply for residency

Apply for Admission

Please complete our secure online admission application for the Faith Home Christian Recovery Program.

You’ll receive an email confirmation from our Admissions team once your form is submitted. If you have any questions, we encourage you to call us at (864) 223-0694 during business hours. We will respond to applications within 24 hours or by the next business day. The phone number MUST be a valid phone number on your application. This is what we’ll use to reach out and verify the application. Failure to reach the applicant will result in the application being denied.

Before you fill out your application, please be sure you’ve reviewed our program policy and procedures:

Program Policy & Procedures
Application

Applicant Information

Name
Name
First Name
Last Name
(mm/dd/yyyy)
Gender
Are You Pregnant?
Example: 864-555-1234
Address
Address
City
State/Province
Zip/Postal
Married

Employment

Program Commitment

(mm/dd/yyyy) You must be alcohol free for 72 hours and clean for a period of seven days from all other drugs and you must be able to pass a drug screen and breathalyzer prior to admission
List all including Alcohol
Are you willing to commit to an (8) week in-house program, at no cost to you or your family?
Are you physically capable of taking care of yourself?
Are you mentally able to comprehend a program of recovery?
Are you presently receiving EBT (food stamps) benefits?
If YES, Please bring your card when you check in.
Do you have a valid drivers license?*

Medical Information

Are you taking any medications or have any medical conditions at this time?
Psychiatric or Mood/Mind altering medications are not allowed.
List all medications you are currently prescribed and taking and for what medical condition.
If on prescribed medication, you must bring enough medication to last the entire 8 week program.
Have you been tested for the HIV virus, Aids, or Hepatitis?
Have you tested POSITIVE for the HIV virus, AIDS or Hepatitis?

Legal Status

Do you have any court dates pending?
Are you on probation or parole?
Applicant must contact probation officer prior to admission. Probation reports must be covered for 8-weeks
Are you a registered sex offender?

Program History

Have you ever been to Faith Home?
(mm/yyyy) If more than once, list last time only.
Did you graduate the program?

Referral Information (Optional)

Example: 864-555-1234

Signature

I state that I have answered this application truthfully and I understand, agree and will comply with the admission rules and policies.

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